Facet Joint Syndrome

Arthritis of the spinal facet joints can be a serious source of back pain. Facet joint syndrome (FJS) occurs when the joints suffer damage from age, injury, or degeneration. The facet joints link each vertebra together, and they are covered with articular cartilage (smooth, rubbery material). With aging and wear, cartilage loss occurs, resulting in spinal arthritis where the bone ends cannot move smoothly.

How common is facet joint syndrome?

According to researchers, facet joint arthritis causes around 30% of chronic low back pain, but the prevalence rate of facet joint syndrome is reported as 4%.

What is the cause of spinal arthritis?

The facet joints should join together snugly and glide without pressure or friction. If pressure builds where the facet joints meet, and the cartilage erodes, facet joint syndrome occurs. Injury or problems with any of the spinal structures will contribute to this condition. When the intervertebral disc age and thin, the spaces between each vertebra shrinks, causing the facet joints to press together. Anything that puts extra stress on the facet joint surface can cause problems with movement or alignment, including torn ligaments, fractures, and disc degeneration.

What are the symptoms of facet joint syndrome?

Facet joint arthritis develops gradually, so symptoms do not develop immediately. However, rapid movements, backward motions, and heavy twisting can cause low back pain from this condition. Pain from spinal arthritis is usually worse upon rising of the morning. In addition, sideways bending will produce pain on the side of the arthritic facet joint. Pain is typically felt in the center of the back (thoracic spine) and the lower region (lumbar spine), and the pain can spread to one or both buttocks. Many patients with facet joint syndrome also have leg symptoms, such as tingling, numbness, and weakness, as this is a result of nerve compression.

What are the treatment options for spinal arthritis?

Treatment for facet joint syndrome will depend on the severity of the pain and the patient’s health status. Options include:

Medications – The pain management specialist will prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to treat the pain associated with facet joint syndrome. For severe pain, oral steroids are used short-term, and if the patient experiences muscle spasms, a muscle relaxant is prescribed.

Physical therapy – The physical therapist evaluates the patient’s condition and develops an exercise plan to help with strengthening back muscles and improving spine flexibility. Pain relief measures include ultrasound, electrical stimulation, and hot/cold therapy.

Facet joint injection (FJI) – Patients who have severe back pain from spinal arthritis can have one or more FJIs. The doctor inserts small needles into the facet joints, using x-ray guidance. A long-acting anesthetic is used as the blocking agent, instilled onto the nerves near the spinal cord. Sometimes, a corticosteroid is injected to offer long-term pain relief. In a recent study, FJI had a 74% success rate.

Medial Branch Block – this procedure places numbing medicine and possibly steroid medication around the facet joint in the region of where the sensory nerve endings bring sensation to the painful joint. These nerve endings are called medial branches, and these blocks may provide months of relief on average.

Facet rhizotomy – This procedure is done to cut or destroy the nerve(s) causing back pain. Using a diagnostic injection (FJI), the doctor identifies the nerves, and inserts a small, hollow needing through the back tissues. A probe is inserted through the needle catheter, which emits heat onto the nerves. Another approach to facet rhizotomy involves the use of laser irradiation, which has a 70% efficacy rate.

Epidural steroid injection (ESI) – With this procedure, a corticosteroid agent is injected into the epidural space, near the spinal cord. According to a recent review of studies, ESI has an 80-90% success rate.

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